Abstract
BackgroundThe extent to which neighbourhood characteristics explain accumulation of health behaviours is poorly understood. We examined whether neighbourhood disadvantage was associated with co-occurrence of behaviour-related risk factors, and how much of the neighbourhood differences in the co-occurrence can be explained by individual and neighbourhood level covariates.MethodsThe study population consisted of 60 694 Finnish Public Sector Study participants in 2004 and 2008. Neighbourhood disadvantage was determined using small-area level information on household income, education attainment, and unemployment rate, and linked with individual data using Global Positioning System-coordinates. Associations between neighbourhood disadvantage and co-occurrence of three behaviour-related risk factors (smoking, heavy alcohol use, and physical inactivity), and the extent to which individual and neighbourhood level covariates explain neighbourhood differences in co-occurrence of risk factors were determined with multilevel cumulative logistic regression.ResultsAfter adjusting for age, sex, marital status, and population density we found a dose-response relationship between neighbourhood disadvantage and co-occurrence of risk factors within each level of individual socioeconomic status. The cumulative odds ratios for the sum of health risks comparing the most to the least disadvantaged neighbourhoods ranged between 1.13 (95% confidence interval (CI): 1.03–1.24) and 1.75 (95% CI, 1.54–1.98). Individual socioeconomic characteristics explained 35%, and neighbourhood disadvantage and population density 17% of the neighbourhood differences in the co-occurrence of risk factors.ConclusionsCo-occurrence of poor health behaviours associated with neighbourhood disadvantage over and above individual's own socioeconomic status. Neighbourhood differences cannot be captured using individual socioeconomic factors alone, but neighbourhood level characteristics should also be considered.
Highlights
Several studies have found associations between neighbourhood socioeconomic characteristics and behaviour-related risk factors [1,2,3,4,5,6,7,8,9], suggesting that neighbourhood characteristics may influence health behaviours of individuals, and that individuals’ choices regarding residential areas may be associated with behaviour-related factors [10]
Risk behaviours tend to cluster within individuals [12], among disadvantaged groups [13,14], and some of this clustering may be linked to shared neighbourhood characteristics
We found that population density and neighbourhood disadvantage aggregated to 161 km squares explained 2.8% of the variance in co-occurrence of risk factors
Summary
Several studies have found associations between neighbourhood socioeconomic characteristics and behaviour-related risk factors [1,2,3,4,5,6,7,8,9], suggesting that neighbourhood characteristics may influence health behaviours of individuals, and that individuals’ choices regarding residential areas may be associated with behaviour-related factors [10]. Risk behaviours tend to cluster within individuals [12], among disadvantaged groups [13,14], and some of this clustering may be linked to shared neighbourhood characteristics. The extent to which neighbourhood level covariates can explain individual behaviours is not clear. The extent to which neighbourhood characteristics explain accumulation of health behaviours is poorly understood. We examined whether neighbourhood disadvantage was associated with co-occurrence of behaviour-related risk factors, and how much of the neighbourhood differences in the co-occurrence can be explained by individual and neighbourhood level covariates
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